Institutional Long-Term Care in Slovenia: How Residential Services Are Changing

For thousands of people already living in Slovenian homes for older people, 1 December 2025 represented an unusual kind of system reform: their address did not change, the familiar institution remained around them and care continued, but the legal and financial basis for much of that care changed. Long-term care in an institution, dolgotrajna oskrba v instituciji, became an entitlement within Slovenia's new long-term care system, with eligible care services financed through mandatory long-term care insurance rather than remaining part of the resident's ordinary institutional-care bill.

The change sits within the wider transformation examined across the Slovenia Ageing, Long-Term Care & Community Support Knowledge Hub. It matters not simply because residents can face lower direct care costs, but because Slovenia is redefining what residential long-term care is for, how it relates to home and community support, how individual need determines service entitlement and how public financing should distinguish care from accommodation.

Institutional care remains essential. Some people need sustained assistance, nursing-related support, supervision or an accessible environment that cannot realistically be provided in their existing home. Yet the strategic context is changing. Residential services now sit within a long-term care settlement that also includes care at home, family caregiving, day care, e-care and support for maintaining independence. The important question is therefore no longer simply how Slovenia funds care homes. It is how institutions evolve as one component of a broader system built around assessed need, choice, continuity and sustainable support.

December 2025 changed the residential care settlement

Slovenia's Long-Term Care Act, Zakon o dolgotrajni oskrbi (ZDOsk-1), introduced rights progressively rather than moving the entire system onto a new basis at once. Institutional long-term care was among the final major rights to become operational, taking effect on 1 December 2025 alongside the monetary benefit.

The reform brought a significant change to the way eligible residential long-term care is financed. Under the new model, long-term care services are financed through mandatory long-term care insurance. Residents remain responsible for accommodation and food: the residential or "hotel" element of living in an institution.

This separation matters. Before the reform, residents and families experienced accommodation and care much more directly as components of the overall institutional cost. The new settlement recognises long-term care itself as an insured social right while preserving a personal contribution towards ordinary living costs.

The reform did not require existing residents who transferred into the new system to move to another home. Transition arrangements were designed to convert eligible existing residents into the long-term care framework while maintaining continuity of residence. That was operationally important: a financing reform should not destabilise the lives of people for whom a care home is already home.

The shift also changes how residential care should be understood within public policy. An institution is no longer simply a social-welfare service purchased through the older charging model. For eligible beneficiaries it is also a location in which statutory long-term care entitlements are delivered and financed.

Institutional entitlement is based on need, not simply age or residence

Living in a home for older people does not by itself define a person's long-term care entitlement. Access to the new system depends on the eligibility conditions established for long-term care, including insurance history, residence and assessed dependency.

A person must have a long-term need for assistance arising from circumstances such as illness, age-related frailty, injury, disability or loss of intellectual capacity and be placed within one of five long-term care categories. Comparable benefits and services cannot generally be received simultaneously where legislation treats them as mutually exclusive.

All five categories can support institutional long-term care. The category determines the recognised volume of direct long-term care services rather than whether institutional care is inherently available only to people at the highest levels of dependency. The monthly framework is 20 hours for Category 1, 40 for Category 2, 60 for Category 3, 80 for Category 4 and 110 for Category 5.

The services can include assistance with basic daily activities, support with instrumental daily activities and nursing activities linked to basic daily living. Beneficiaries are also entitled, according to the applicable category and arrangements, to services intended to strengthen and maintain independence.

This creates an important connection with person-centred planning and strengths-based support. Two people occupying neighbouring rooms may require very different patterns of assistance even when both need residential support. Institutional efficiency should not erase that distinction.

The resident's bill now separates care from living costs

The most immediately visible consequence of the reform for many households is financial. Long-term care services within the institutional entitlement are funded from mandatory long-term care insurance during the current implementation period, while the resident pays for accommodation and food.

Slovenia has also placed a ceiling on the standard accommodation and food charge, linking it to the level of the guaranteed pension. This creates a national affordability safeguard around the standard residential component rather than leaving the full institutional price exposed to variation in care intensity.

Accommodation can still differ from the standard offer. Room type, amenities and whether accommodation is above or below the defined standard can affect the amount charged. The principle is therefore not that every resident receives an identical invoice, but that long-term care services themselves are separated from the accommodation and food element and standard accommodation is subject to the statutory ceiling.

Where a resident cannot afford the applicable accommodation and food contribution, Slovenia retains a social-protection mechanism. The competent centre for social work, center za socialno delo, can determine partial or full exemption according to the person's material circumstances and the relevant contribution rules. Where required contributions do not meet the eligible cost, public funding arrangements address the remaining amount in accordance with the applicable rules.

This produces a layered financing model:

• mandatory long-term care insurance finances eligible long-term care services;
• mandatory health insurance continues to finance healthcare and rehabilitation falling within healthcare responsibilities;
• the resident pays the applicable accommodation and food element; and
• means-related protection can reduce that accommodation and food liability where the statutory conditions are met.

The distinction is more than accounting. It makes clearer which costs arise because a person needs long-term care and which arise because they live in residential accommodation.

A lower care bill does not solve the question of residential capacity

Improving financial accessibility does not automatically create additional rooms, workers or specialist capacity. Slovenia's institutional reform therefore has to be assessed through both affordability and availability.

Consider an 84-year-old woman living alone after repeated falls and increasing cognitive impairment. Her daughter provides substantial support, but night-time risk and deteriorating mobility make the existing arrangement unsustainable. Assessment establishes long-term care eligibility and the family considers institutional care the most appropriate option.

Insurance coverage makes the care component more financially predictable, but the practical pathway still depends on a suitable place being available. The woman may have preferences about location because remaining close to her daughter matters to both of them. A vacancy elsewhere in Slovenia is not necessarily an equivalent outcome if distance makes regular family involvement difficult.

Capacity therefore has several dimensions: total beds, location, suitability, workforce and the ability to support particular levels or types of need. A system can have nominal capacity while still having local shortages or mismatches between available provision and the needs of people waiting.

This makes demand, capacity and waiting-list management relevant beyond homecare itself. National and local intelligence needs to distinguish between someone waiting because no bed exists, someone waiting for a preferred location and someone whose needs require provision that only some institutions can safely deliver.

Organisations examining comparable capacity questions can use the Digital Twin Scenario Modeller to explore relationships between demand, workforce, service capacity and stability. It is not a Slovenian planning instrument, but scenario modelling can help system leaders understand why adding theoretical capacity without the workforce to operate it does not resolve access.

Choice between home and institutional care becomes more meaningful

A central ambition of a mature long-term care system is not to make either home care or institutional care the automatic destination. It is to make the available options sufficiently credible that individual preference can carry real weight.

Slovenia's reform strengthens that principle by placing different long-term care rights within one framework. An eligible person may choose institutional long-term care where it best meets their circumstances, while another may use home-based care, a family caregiver arrangement or another applicable right.

The distinction matters because debates about "ageing in place" can become too simplistic. Remaining at home can preserve familiarity, community connection and autonomy, but home is not automatically the safest or most person-centred setting. An inaccessible apartment, profound isolation, severe night-time needs or exhausted family support can make institutional care a positive choice rather than evidence that community support has failed.

Conversely, institutional admission should not become the default simply because community services are temporarily unavailable. Where someone's preferred form of long-term care cannot immediately be provided for reasons on the provider side, the Slovenian framework allows alternative rights under defined arrangements while the preferred service is unavailable.

That creates an important governance test. Alternative provision should protect the person during a capacity gap, but repeated use of alternatives should also reveal where the system is not providing people's preferred form of support.

Transitioning existing residents required more than changing invoices

The December 2025 transition was operationally unusual because a large existing residential population had to move into a new statutory framework without disrupting day-to-day care. Slovenia established conversion arrangements for people already living in homes for older people, including processes for obtaining consent and addressing circumstances such as guardianship.

Imagine a resident with advanced dementia who had lived in the same home for four years before the reform. She was already receiving substantial personal and nursing support, and her affairs were managed with the involvement of a legal representative and close family.

For her, successful implementation could not be measured by whether an administrative conversion happened by the correct date alone. The important outcomes were continuity of familiar care, correct recognition of her needs, lawful representation in the transition process, accurate financial changes and clear communication with the family.

A poorly managed transition could have created uncertainty without changing a single physical care task. A well-managed one makes the legal and financial reform almost invisible in daily life while ensuring that the resident's new entitlement is correctly established.

This illustrates a wider principle of decision-making and escalation: major system change needs mechanisms for exceptional cases. Standard conversion processes are necessary for scale, but guardianship, disputed representation, incomplete records or changing needs require routes for issues to be identified and resolved rather than pushed through a uniform workflow.

The personal plan must prevent institutional care becoming standardised care

Residential environments inevitably organise collective routines. Meals have to be prepared, workers deployed, medication managed, communal areas maintained and night cover sustained. The risk is that operational efficiency begins to determine individual life more strongly than assessed need and personal preference.

Slovenia's long-term care framework provides a counterweight through individual assessment and personal planning. The beneficiary's care category establishes an entitlement framework, while the personal plan translates recognised need into actual support.

That process should remain meaningful inside an institution. A resident who can wash independently but needs help dressing should not automatically receive the same morning routine as someone requiring complete personal care. A person who prefers to rise later should not lose that preference solely because staffing patterns are easier if everyone is prepared for breakfast at the same time.

Person-centred residential care also involves risk. Someone may want to walk independently despite falls risk, spend time outside the institution, retain control over aspects of medication or maintain routines that staff perceive as less convenient. The objective is neither unrestricted risk nor institutional risk elimination. It is proportionate decision-making that respects autonomy while recognising foreseeable harm.

The wider principles of positive risk-taking and risk enablement for older people therefore remain important within residential settings. Organisations exploring similar decisions can use the Positive Risk-Taking Planner to structure consideration of choice, benefit, foreseeable harm and safeguards. It does not replace Slovenian law or professional judgement, but it demonstrates how risk decisions can remain connected to the person's goals rather than becoming automatic restrictions.

Residential care sits at the boundary between long-term care and healthcare

One of the most important distinctions in Slovenia's institutional model is between long-term care and healthcare. Long-term care insurance finances the defined assistance and nursing activities within the long-term care entitlement. Healthcare and rehabilitation that belong to the healthcare system continue to be financed through mandatory health insurance.

Residents do not experience those financing boundaries in the same way as institutions do. A frail resident may need help dressing, wound management, medication review, physiotherapy and medical assessment within the same week. From the person's perspective these needs form one experience of health and daily living.

Operationally, however, responsibilities need to remain clear. Staff must know which activity sits within long-term care, when healthcare professionals need to become involved and how changes in health status are communicated. Financial separation should not create fragmented practice.

Consider an 89-year-old resident who develops increasing breathlessness, reduced appetite and confusion over several days. Care workers notice the changes during routine assistance. The response cannot stop at recording that scheduled long-term care was delivered. The deterioration needs to trigger appropriate clinical assessment through the healthcare pathway.

Equally, information from that clinical assessment may alter the resident's daily support. Mobility assistance, nutrition, hydration or observation may need to change. Effective institutional care therefore depends on information moving in both directions.

This makes the principles of medicines, frailty, falls and safety central to residential quality. The institutional environment can make multidisciplinary working easier because staff and residents are geographically concentrated, but proximity alone does not create integration. Roles, communication and escalation still need to function reliably.

Workforce determines how much reform residents actually experience

Changing who finances long-term care does not change the fact that care is delivered by people. Residential services require sufficient numbers of appropriately skilled workers across the entire day and night, including weekends and holidays. They also need nursing expertise, leadership, supervision, domestic and support functions and access to healthcare professionals.

Slovenia faces the same fundamental demographic tension confronting many European care systems: demand for long-term support is increasing while the labour available to provide labour-intensive care is constrained. Residential institutions feel that pressure acutely because a staffing shortage affects multiple residents simultaneously.

The workforce question extends beyond vacancies. Retention matters because experienced staff understand residents' routines and can recognise subtle changes. Skill mix matters because increasingly complex needs require different competencies. Working conditions matter because physically and emotionally demanding jobs are difficult to sustain where staffing is persistently stretched.

Migration can supplement domestic labour supply, but international recruitment also creates requirements around language, induction, professional recognition, cultural understanding and retention. Recruiting a worker is not the same as creating stable capacity.

A residential provider may therefore appear fully staffed in headline numbers while remaining operationally vulnerable. If a small group of experienced nurses carries most clinical oversight, several departures can destabilise the service even if overall headcount changes only modestly.

The relevant connection with workforce, skill mix and practice competence is direct. For organisations examining similar vulnerabilities, the Predictive Workforce Risk Module offers a way to structure analysis of turnover, vacancy, retention and continuity risks before they translate into unstable care. It is not designed to determine Slovenian staffing requirements.

A vacancy is not merely an HR problem when thirty residents depend on the rota

Consider a medium-sized home for older people outside Ljubljana. Several experienced workers retire within a short period and recruitment takes longer than expected. Agency or temporary cover is available only intermittently. The institution remains open and residents continue receiving essential support, but pressure begins to appear in less visible ways.

Bathing schedules become harder to maintain. Activities are cancelled because staff are redeployed. Familiar workers have less time for conversation. Documentation is completed later. Permanent employees take additional shifts and sickness absence begins to increase.

No single event necessarily indicates unsafe care, yet the pattern is an early warning of declining resilience.

A mature governance response would connect these signals rather than reviewing them separately. Vacancy levels, overtime, sickness, missed or delayed activities, incidents, complaints and resident feedback can reveal whether staffing pressure is affecting lived experience. Managers can then distinguish a temporary recruitment gap from a structural workforce problem requiring changes to deployment, skill mix or service capacity.

The scenario also shows why workforce productivity cannot be reduced to making each employee complete more tasks. Residential care includes relational work: noticing deterioration, reassuring someone with dementia, helping a resident make a choice or speaking with a worried relative. Removing every apparent period of "unused" staff time can remove the capacity that allows those interactions to happen.

Quality assurance must follow the resident, not only the institution

Institutional settings generate substantial quantities of information. Care records, medication information, incidents, complaints, staffing data, health events and assessments can all contribute to oversight. The challenge is turning those records into an accurate picture of whether people are living well.

Traditional institutional measures can overemphasise what is easiest to count. Occupancy, staffing establishment, incidents and completed tasks matter, but they do not by themselves show whether residents have meaningful choice, maintain relationships, experience continuity or retain abilities that matter to them.

The new long-term care system creates an opportunity to connect statutory entitlement more explicitly with outcomes. If a person's personal plan is intended to maintain independence, review should consider whether that is happening. If a resident repeatedly becomes distressed during personal care, completion of the task is not sufficient evidence of quality.

Strong quality data, KPIs and performance metrics should therefore combine safety, delivery, workforce and experience rather than treating them as separate governance worlds.

For organisations developing comparable oversight, the Quality Dashboard Builder can help bring indicators together into a more coherent assurance view. In Slovenia, the specific measures and accountability routes must reflect national legislation and institutional responsibilities, but the governance principle travels well: information becomes useful when decision-makers can see relationships between operational pressure and human outcomes.

Residential quality includes the right to an ordinary life

An institution is a service environment, but it is also the resident's home. This dual identity creates one of the enduring tensions in residential care.

Safety procedures are necessary. Food hygiene, medication control, infection prevention, emergency preparedness and staffing arrangements cannot simply be individualised away. At the same time, an excessive institutional culture can make residents' lives revolve around organisational routines.

A resident's priorities may include drinking coffee with a neighbour, keeping personal furniture, going into town, spending private time with a partner, attending religious or cultural activities, deciding when to sleep or continuing a hobby. These outcomes can matter as much to wellbeing as formally recorded care tasks.

For a resident with dementia, ordinary life may depend on familiar objects, consistent workers, understandable environments and relationships with family. For someone with physical disability, it may depend on accessible space, equipment and the ability to leave the institution independently.

Quality therefore requires more than absence of harm. The principles within outcomes, independence and community inclusion remain relevant even where someone needs 24-hour residential support.

This is particularly important as Slovenia's residential sector modernises. Better buildings and digital systems can improve care, but institutional modernisation should also ask whether environments enable autonomy, relationships and connection with the surrounding community.

Families remain part of residential care after admission

Admission to an institution changes family caregiving; it does not necessarily end it. Relatives may continue visiting, accompanying residents to appointments, supporting decision-making, providing emotional connection and helping staff understand preferences and history.

For some families, residential admission follows years of intensive unpaid care. They may experience relief alongside guilt, grief or anxiety about losing control over the person's support. Good institutional practice recognises this transition rather than treating relatives simply as visitors.

Consider a husband whose wife enters a home after dementia and night-time wandering make care at home unsustainable. He has managed her routines for years and knows which music calms her, how she communicates discomfort and why she becomes distressed at certain times of day.

The institution has professional responsibility for her care, but disregarding his knowledge would discard valuable evidence. Equally, expecting him to continue performing essential care tasks every day would undermine the purpose of formal residential support.

The appropriate relationship is partnership with boundaries. Staff should understand what family members know and what involvement the resident wants, while professional accountability remains with the provider. Where the resident cannot communicate preferences straightforwardly, lawful decision-making and representation become especially important.

This reflects the wider principle of family partnership and carer support. Residential care works best when admission redistributes responsibility without erasing relationships.

Safeguarding in institutions requires both controls and resident voice

Residential environments concentrate people who may have significant dependency, cognitive impairment or communication difficulty. They also concentrate organisational power: staff control access to assistance, information, medication and many aspects of daily routine. That makes safeguarding an integral part of institutional governance.

Risks can include neglect, financial exploitation, psychological or physical abuse, inappropriate restriction, peer-to-peer harm and failures to respect privacy or consent. Workforce pressure can increase vulnerability if rushed care becomes normalised or residents have limited access to familiar staff.

Formal controls are necessary, but safeguarding cannot rely only on incident reporting. Residents and families need credible ways to express concerns. Staff need confidence to escalate poor practice. Managers need to recognise patterns that may be individually minor but collectively significant.

A rise in falls, unexplained injuries, complaints about delayed toileting and increasing sickness absence may each have different explanations. Viewed together, they may indicate staffing or practice pressure requiring investigation.

The connection with safeguarding audit, assurance and oversight is therefore important. The objective is not simply to demonstrate that policies exist, but to understand whether organisational conditions support dignity and protection in everyday life.

For institutions examining comparable governance maturity, the Governance Maturity Assessment can help leaders test how risk, assurance, escalation and learning connect. It does not certify Slovenian regulatory compliance and should not be treated as a substitute for national oversight requirements.

Technology can make institutions more responsive without making them more institutional

Residential settings offer significant opportunities for digital support. Electronic records can improve continuity, sensors may support falls prevention or night-time safety, digital communication can connect residents with families, and workforce systems can improve deployment.

Yet residential technology also creates particular ethical questions because monitoring can easily become pervasive. A device capable of recording movement continuously may improve safety while also reducing privacy. The appropriate balance depends on purpose, proportionality, consent and the person's circumstances.

Technology should therefore solve identifiable problems rather than be introduced because an institution wishes to appear modern. A sensor that allows a resident at risk of falls greater freedom of movement may support autonomy. Continuous monitoring that produces no meaningful response or merely substitutes surveillance for human contact adds less value.

Digital records also need to support rather than fragment the health and long-term care interface. Re-entering the same information into disconnected systems consumes workforce time and increases the possibility that important changes will not reach the people who need them.

The wider themes of interoperability and system integration will become increasingly relevant as Slovenia develops its long-term care information infrastructure. Digital maturity should ultimately make coordination easier for residents and workers, not add another administrative layer.

The future role of institutions is likely to become more specialised

As home-based support expands, the strategic role of residential services can change. If more people with moderate needs are able to remain at home for longer, institutions may increasingly support residents with higher dependency, dementia, complex health conditions or circumstances in which continuous support is necessary.

This is not an automatic outcome, and Slovenia should not assume that every future resident will have very high needs. Choice remains important. But a successful community-care strategy commonly changes the profile of people who eventually enter residential services.

That has consequences for buildings, workforce and clinical interfaces. Homes designed around relatively independent residents may need more accessible environments, equipment and dementia-friendly spaces. Workforce models may require stronger nursing and specialist competence. Relationships with primary and specialist healthcare become increasingly important.

Institutions may also have a broader community role. Day long-term care, temporary support, respite and specialist expertise can allow residential infrastructure to serve people who do not live permanently in the building. The boundary between "the care home" and "community care" can become more permeable.

This creates a stronger opportunity than simply expanding bed numbers. Residential infrastructure can form part of a local long-term care network in which expertise, equipment and workforce are used flexibly while permanent institutional residence remains one option among several.

Transitions into and out of residential care deserve greater attention

Institutional care is sometimes discussed as an endpoint, yet people enter residential services through different pathways. Some move after gradual deterioration at home. Others arrive following hospitalisation, rehabilitation or a sudden loss of family support. The quality of that transition can shape the resident's subsequent experience.

Imagine an older man admitted to hospital after a hip fracture. Before the fall he lived alone with limited assistance. After acute treatment he is medically stable but cannot immediately manage safely at home. The system needs to distinguish whether he requires permanent institutional long-term care, temporary rehabilitation, intensified home support or another transitional arrangement.

If residential admission becomes the default because it is the easiest service to organise quickly, a temporary functional decline can become a permanent life change. Conversely, delaying an appropriate institutional placement in pursuit of an unrealistic return home can prolong hospitalisation and increase distress.

The decision therefore requires evidence about function, rehabilitation potential, home circumstances, available support and the person's own preferences. It also requires coordination between healthcare and long-term care rather than a binary choice made at the hospital door.

For people already in an institution, needs can also change. Some may regain function; others may require increasing specialist support. Personal planning should retain the possibility of reviewing whether the current arrangement remains the most appropriate one rather than assuming placement is irreversible.

System oversight needs to distinguish affordability, access and quality

Slovenia's institutional reform creates several different questions that should not be collapsed into one measure of success.

Affordability asks whether the new financing model has reduced the direct care burden on residents and whether accommodation remains financially manageable. Access asks whether people who choose institutional care can obtain a suitable place within a reasonable period and acceptable distance from their community. Quality asks what life and care are actually like once they enter.

A system could improve one dimension while struggling with another. Lower bills do not demonstrate sufficient capacity. Higher occupancy does not demonstrate good outcomes. More beds do not guarantee the workforce required to operate them safely.

National oversight therefore benefits from a balanced evidence set covering areas such as:

• demand, waiting and geographic availability;
• resident costs and use of financial exemptions;
• workforce vacancies, turnover, skill mix and continuity;
• care delivery, incidents and health-related escalation;
• resident and family experience, complaints and safeguarding concerns; and
• independence, participation and other person-centred outcomes.

The value lies in connecting these measures. Persistent vacancies alongside deteriorating continuity and rising complaints warrant a different response from a temporary recruitment gap with stable resident outcomes.

As the system matures, longitudinal evidence will also matter. Slovenia will be able to examine whether stronger home care changes the dependency profile of new residential admissions, whether institutional stays begin later in life and whether different regions experience different patterns of demand.

Residential reform is part of a wider rebalancing of long-term care

The strategic importance of Slovenia's reform lies in the relationship between settings. Institutional care is no longer the only highly visible pillar around which long-term support is organised. Home care, family-caregiver rights, e-care, day services and monetary support create a broader range of possibilities.

That should allow residential provision to be used because it is appropriate rather than because other forms of support are insufficiently developed. Achieving that balance will take time. Existing infrastructure, workforce distribution and public expectations do not change simply because legislation creates new rights.

There is also a risk in interpreting rebalancing as a competition between institutions and community care. Slovenia needs both. A growing older population will include people who can live independently with modest support, people who need intensive assistance at home and people for whom a well-run residential environment provides the strongest combination of safety, companionship, care and clinical access.

The policy task is therefore to develop a continuum rather than defend one setting against another. Funding should not create unnecessary incentives towards a particular location. Assessment should recognise actual need. Workforce planning should consider the whole long-term care system rather than institutions and home services in isolation.

The experience offers an international lesson. The transferable principle lies less in Slovenia's particular insurance mechanism than in separating the question "who pays for care?" from the question "where should this person live?" A financing reform is strongest when it expands genuine choice rather than simply moving costs between budgets.

Conclusion

Institutional long-term care remains a fundamental part of Slovenia's care system, but its place within that system is changing. Since December 2025, eligible long-term care services in institutions have been brought within the new insurance-based entitlement, while residents remain responsible for accommodation and food subject to the applicable safeguards. That separation has changed household costs and clarified the distinction between care, healthcare and ordinary living expenses.

The deeper transformation will take longer. Residential services need to operate within a system in which assessed need, personal planning and choice matter across institutional and community settings. Workforce capacity must support increasingly complex residents. Healthcare and long-term care responsibilities need to connect around daily life. Quality oversight must look beyond occupancy and completed tasks towards continuity, dignity, autonomy, relationships and outcomes.

Slovenia's strongest opportunity is not to treat residential reform as the modernisation of a separate institutional sector. It is to make institutions part of a flexible long-term care network in which people can move between home, community, rehabilitation and residential support according to changing need.

The success of that settlement will ultimately be judged less by the mechanism that pays the care bill than by what residents experience after the reform reaches their room: whether support is dependable, whether relationships are respected, whether risk is managed proportionately and whether an institution remains recognisably a place to live rather than simply a place to receive care.